Jan Griewatz

Impact of Scientific Versus Emotional Wording of Patient Questions on Doctor-Patient Communication in an Internet Forum: A Randomized Controlled Experiment with Medical Students.

Background Medical expert forums on the Internet play an increasing role in patient counseling. Therefore, it is important to understand how doctor-patient communication is influenced in such forums both by features of the patients or advice seekers, as expressed in their forum queries, and by characteristics of the medical experts involved. Objective In this experimental study, we aimed to examine in what way (1) the particular wording of patient queries and (2) medical experts’ therapeutic health concepts (for example, beliefs around adhering to a distinctly scientific understanding of diagnosis and treatment and a clear focus on evidence-based medicine) impact communication behavior of the medical experts in an Internet forum. Methods Advanced medical students (in their ninth semester of medical training) were recruited as participants. Participation in the online forum was part of a communication training embedded in a gynecology course. We first measured their biomedical therapeutic health concept (hereinafter called “biomedical concept”). Then they participated in an online forum where they answered fictitious patient queries about mammography screening that either included scientific or emotional wording in a between-group design. We analyzed participants’ replies with regard to the following dimensions: their use of scientific or emotional wording, the amount of communicated information, and their attempt to build a positive doctor-patient relationship. Results This study was carried out with 117 medical students (73 women, 41 men, 3 did not indicate their sex). We found evidence that both the wording of patient queries and the participants’ biomedical concept influenced participants’ response behavior. They answered emotional patient queries in a more emotional way (mean 0.92, SD 1.02) than scientific patient queries (mean 0.26, SD 0.55; t 74=3.48, P<.001, d=0.81). We also found a significant interaction effect between participants’ use of scientific or emotional wording and type of patient query (F 2,74=10.29, P<.01, partial η2=0.12) indicating that participants used scientific wording independently of the type of patient query, whereas they used emotional wording particularly when replying to emotional patient queries. In addition, the more pronounced the medical experts’ biomedical concept was, the more scientifically (adjusted β=.20; F 1,75=2.95, P=.045) and the less emotionally (adjusted β=–.22; F 1,74=3.66, P=.03) they replied to patient queries. Finally, we found that participants’ biomedical concept predicted their engagement in relationship building (adjusted β=–.26): The more pronounced their biomedical concept was, the less they attempted to build a positive doctor-patient relationship (F 1,74=5.39, P=.02). Conclusions Communication training for medical experts could aim to address this issue of recognizing patients’ communication styles and needs in certain situations in order to teach medical experts how to take those aspects adequately into account. In addition, communication training should also make medical experts aware of their individual therapeutic health concepts and the consequential implications in communication situations.

Peer-assisted learning (PAL) in undergraduate medical education: An overview

Peer-assisted learning (PAL) has a long tradition and is nowadays implemented in the curricula of most medical faculties. Besides traditional areas of application like problem-based learning, anatomy, or CPR, more and more departments and institutes have established PAL as part of their everyday teaching. This narrative review provides some background information and basic definitions of PAL. It offers an overview on features and determinants as well as underlying learning theories and developments in PAL. In addition, motives for implementation are highlighted followed by a comparison of advantages and disadvantages. After outlining aspects of quality management including the training of tutors and the evaluation and acceptance of PAL formats, this review concludes with an outlook on how PAL can proceed into the future and where further research is necessary.

Development of a seminar on medical professionalism accompanying the dissection course

INTRODUCTION Medical professionalism is an increasingly important issue in medical education. The dissection course represents a profound experience for undergraduate medical students, which may be suitable to address competencies such as self-reflection and professional behavior. MATERIAL AND METHODS Based on a needs assessment, a seminar on medical professionalism was developed to parallel the dissection course. The conceptual framework for the teaching intervention is experiential learning. Specific learning goals and an interview guideline were formulated. After a pilot run, peer-teaching was introduced. RESULTS Over three terms (winter 2012/13, 2013/14, 2014/15), an average of 129 students voluntarily participated in the seminar, corresponding to 40% of the student cohort. The evaluation (n=38) shows a majority of students agreeing that the seminar offers support with this extraordinary situation in general and also that the seminar helps them to become first impressions on how to cope with death and dying in their later professional life as a doctor, and, that it also provides them the means to reflect upon their own coping mechanisms. CONCLUSION Although not yet implemented as an obligatory course, the seminar is appreciated and positively evaluated. Medical professionalism is an implicit aspect of the dissection course. To emphasize its importance, a teaching intervention to explicitly discuss this topic is advisable.

Building an audio/video-feedback system for simulation training in medical education

Abstract Background: Simulation training in medical education is a valuable tool for skill acquisition. Standard audio/video-feedback systems for training surveillance and subsequent video feedback are expensive and often not available. Methods: We investigated solutions for a low-budget audio/video-feedback system based on consumer hardware and open source software. Results: Our results indicate that inexpensive, movable network cameras are suitable for high-quality video transmission including bidirectional audio transmission and an integrated streaming platform. In combination with a laptop, a WLAN connection, and the open source software iSpyServer, one or more cameras represent the easiest, yet fully functional audio/video-feedback system. For streaming purposes, the open source software VLC media player yields a comprehensive functionality. Using the powerful VideoLAN Media Manager, it is possible to generate a split-screen video comprising different video and audio streams. Optionally, this system can be augmented by analog audio hardware. In this paper, we present how these different modules can be set up and combined to provide an audio/video-feedback system for a simulation ambulance. Conclusions: We conclude that open source software and consumer hardware offer the opportunity to build a low-budget, feature-rich and high-quality audio/video-feedback system that can be used in realistic medical simulations.

Medical teachers' perception of professional roles in the framework of the German National Competence-Based Learning Objectives for Undergraduate Medical Education (NKLM)-A multicenter study.

Abstract Background: Based on CanMEDS and others, the German National Competence-Based Learning Objectives for Undergraduate Medical Education (NKLM) were recently consented. International studies recommend integrating national and cultural context when transferring a professional roles framework in different countries. Teachers’ misconceptions may establish barriers in role understanding and implementation. Objectives: The aim is to analyze medical teachers’ rating and perception of NKLM roles in order to reveal differences to official definitions. Methods: A two-step sequential mixed methods design was used including a survey and focus groups with N = 80 medical teachers from four German universities. Results: Most of the teachers highly valued the importance of the role “Medical Expert” and understood comprehensively. The Communicator and the Collaborator were rated fairly and perceived to a large extent. Other intrinsic roles like Health Advocate and Scholar showed more deficits in perception and less importance by the participants. This was seen generally problematic and should be considered carefully. Manager and professional showed one-sided weaknesses either in importance or perception. Conclusion: Medical teachers considered NKLM roles relevant for medical practice, although their role perception differed considerably. The value and risk matrix visualizes the specific role profile and offers strategic implications for NKLM communication and handling, thus supporting change management.

Using simulated forums for training of online patient counselling.

What problems were addressed? A central challenge of medical education, across all disciplines, is keeping up with rapidly evolving – and expanding – foundational knowledge. It may be particularly difficult for programmes and departments with relatively small numbers of core teaching faculty staff to design andmaintain their own comprehensive curricula. One approach to assist programmes with this challenge has been to create and disseminate shared curriculum resources. This approach, however, still requires significant faculty effort that may exceed what any individual or small group may be able to provide. What was tried? The National Neuroscience Curriculum Initiative (NNCI; www.nncionline.org) represents one approach for sharing resources. The NNCI is designed around a series of ‘modules’ that represent specific teaching methods built on principles of adult learning. Within each module are individual sessions that focus on neuroscience content. Initial feedback on the NNCI has been extremely positive with regard to the teaching approaches: for example, in the 1.5 years since its inception, at least 40 residency programmes have implemented NNCI materials. The primary request from end users has been for the development of more specific content. To facilitate expansion of content, the NNCI pioneered ‘crowdsourcing’ events at two separate conferences with a combined attendance of over 200. Each was a specialised event for educators who were interested in improving the teaching of neuroscience at their host programmes. At each event, an expert faculty member demonstrated a sample class from the Neuroscience in the Media (NITM) module. In a second session, participants were divided into small groups and asked to write their own sample sessions with new content following the NITM format. Moderators were available to assist anyone with questions. Responses were submitted online and recorded directly into a database. What lessons were learned? In total, these events generated 100 new submissions across a range of neuroscience topics (and according to participants’ areas of interest). By leveraging the strengths of our audience, we were able to exponentially increase productivity. Feedback from the experience was generally positive: 75% of participants rated the session as effective. Many individuals reported initially feeling scared or intimidated by the prospect of teaching this module and then empowered by having written their own material. For example, one participant wrote: ‘This was my favourite session of the day. It was so great to know that I could actually do what you are teaching.’ Another described the session as a ‘revolutionary experience’. The biggest limitation has been the need to edit the large amount of content generated. The majority of submissions were in relatively rough form, necessitating both copyediting and review for scientific accuracy. As one response to this, we are posting some of the more promising submissions as ‘rough cuts’ with the caveat to readers that they have not undergone expert review. To the best of our knowledge, this is the first time that crowdsourcing has been used in graduate medical education. We believe this is a creative and effective approach to collaboratively develop shared curriculum resources.

Factors associated with delayed defibrillation in cardiopulmonary resuscitation: A prospective simulation study

Introduction Early defibrillation is an important factor of survival in cardiac arrest. However, novice resuscitators often struggle with cardiac arrest patients. We investigated factors leading to delayed defibrillation performed by final-year medical students within a simulated bystander cardiac arrest situation. Methods Final-year medical students received a refresher lecture and basic life support training before being confronted with a simulated cardiac arrest situation in a simulation ambulance. The scenario was analyzed for factors leading to delayed defibrillation. We compared the time intervals the participants needed for various measures with a benchmark set by experienced resuscitators. After training, the participants were interviewed regarding challenges and thoughts during the scenario. Results The median time needed for defibrillation was 158 s (n = 49, interquartile range: 107–270 s), more than six-fold of the benchmark time. The major part of total defibrillation time (49%; median, n = 49) was between onset of ventricular fibrillation and beginning to prepare the defibrillator, more specifically the time between end of preparation of the defibrillator and actual delivery of the shock, with a mean proportion of 26% (n = 49, SD = 17%) of the overall time needed for defibrillation (maximum 67%). Self-reported reasons for this delay included uncertainty about the next step to take, as reported by 73% of the participants. A total of 35% were unsure about which algorithm to follow. Diagnosing the patient was subjectively difficult for 35% of the participants. Overall, 53% of the participants felt generally confused. Conclusions Our study shows that novice resuscitators rarely achieve guideline-recommended defibrillation times. The most relative delays were observed when participants had to choose what to do next or which algorithm to follow, and thus i.e. performed extensive airway management before a life-saving defibrillation. Our data provides a first insight in the process of defibrillation delay and can be used to generate new hypotheses on how to provide a timely defibrillation.

Benchmarking for research-related competencies – a curricular mapping approach at medical faculties in Germany

Abstract Objectives: Internationally, scientific and research-related competencies need to be sufficiently targeted as core outcomes in many undergraduate medical curricula. Since 2015, standards have been recommended for Germany in the National Competency-based Learning Objective Catalogue in Medicine (NKLM). The aim of this study is to develop a multi-center mapping approach for curricular benchmarking against national standards and against other medical faculties. Method: A total of 277 faculty members from four German medical faculties have mapped the local curriculum against the scientific and research-related NKLM objectives, using consented procedures, metrics, and tools. The amount of mapping citations of each objective is used as indicator for its weighting in the local curriculum. Achieved competency levels after five-year education are compared. Results: All four programs fulfill the NKLM standards, with each emphasizing different sub-competencies explicitly in writing (Scholar: 17–41% of all courses; Medical Scientific Skills: 14–37% of all courses). Faculties show major or full agreement in objective weighting: Scholar 44%, scientific skills 79%. The given NKLM competency level is met or even outperformed in 78–100% of the courses. Conclusions: The multi-center mapping approach provides an informative dataset allowing curricular diagnosis by external benchmarking and guidance for optimization of local curricula.

Gründe für eine verzögerte Defibrillation

Redaktion M. Buerke, Siegen C. Castan · A. Münch · M. Mahling · L. Haffner · J. Griewatz · A. HermannWerner · R. Riessen · J. Reutershan · N. Celebi 1 Klinik für Kardiologie, Angiologie und Pneumologie, Klinikum Esslingen, Esslingen, Deutschland 2 Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Tübingen, Tübingen, Deutschland Medizinische Klinik IV, Abteilung für Endokrinologie, Diabetologie, Angiologie, Nephrologie, Universitätsklinikum Tübingen, Tübingen, Deutschland

Erratum to: Building an audio/video-feedback system for simulation training in medical education

aMoritz Mahling and Alexander Münch contributed equally to this work. *Corresponding author: Christoph Castan, Medical School, Faculty of Medicine, University of Tübingen, 72076 Tübingen, Germany, E-mail: christoph.castan@agn-tuebingen.de Moritz Mahling, Alexander Münch and Leopold Haffner: Medical School, Faculty of Medicine, University of Tübingen, Tübingen, Germany Paul Schubert, Andreas Manger and Jörg Reutershan: Department of Anesthesiology and Intensive Care Medicine, University of Tübingen, Tübingen, Germany Jan Griewatz: Competence Centre for University Teaching in Medicine, Faculty of Medicine, University of Tübingen, Tübingen, Germany Nora Celebi: Ärztezentrum Ostend, Stuttgart, Germany Reimer Riessen: Department of Internal Medicine, Medical Intensive Care Unit, University of Tübingen, Tübingen, Germany Verena Conrad: DocLab, Faculty of Medicine, University of Tübingen, Tübingen, Germany Anne Herrmann-Werner: DocLab, Faculty of Medicine, University of Tübingen, Tübingen, Germany; and Department of Internal Medicine, Psychosomatic Medicine and Psychotherapy, University of Tübingen, Tübingen, Germany Erratum